MAUDE Adverse Event Report: HEARTWARE, INC. HEARTWARE VENTRICULAR ASSIST SYSTEM - PUMP; VENTRICULAR (ASSISST) BYPASS

Model Number 1104

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Hematoma (1884); Pain (1994); Thrombosis/Thrombus (4440); Unspecified Hepatic or Biliary Problem (4493)

Event Date 08/10/2019

Event Type  Injury  

Manufacturer Narrative

This regulatory report is being submitted as part of a retrospective review and remediation per (b)(4).This information was received from the mechanical circulatory support product surveillance registry study.Product event summary: hw28766 was not returned for evaluation.This complaint is associated with a clinical adverse event.Information received from the site indicated that the patient was hospitalized due to left and right lower quadrant (llq, rlq) pain.A compute tomography (ct) confirmed acute cholecystitis and medication was started.A clot drainage was performed since it was believed that the cholecystitis was due to hepatic hilum obstruction by hematoma.The patient was discharged and re-hospitalized for cholecystectomy, and although the hematoma decreased it was still not adequate for operation.The patient was discharged and hospitalized a third time where a cholecystectomy was done.Based on the available information, the device may have caused or contributed to the reported event.There was no evidence the patient had a history of similar adverse events.Possible clinical factors that may have contributed to this event include the patient¿s pre-existing history and related comorbidities, the progression of their underlying disease, issues related to the therapeutic use of anticoagulant and antiplatelet medications and the patient's complex post-operative course.There are possible patient, pharmacological and procedural factors that may have contributed to this event.Investigation of this event is completed and the file will be closed.If new information is received, the file will be re-opened and a supplemental will be submitted.If information is provided in the future, a supplemental report will be issued.

Event Description

It was reported that the patient was hospitalized due to left and right lower quadrant (llq, rlq) pain.A compute tomography (ct) confirmed acute cholecystitis and medication was started.A clot drainage was performed since it was believed that the cholecystitis was due to hepatic hilum obstruction by hematoma.The patient was discharged and re-hospitalized for cholecystectomy, and although the hematoma decreased it was still not adequate for operation.The patient was discharged and hospitalized a third time where a cholecystectomy was done.The ventricular assist device (vad) remains in use.No further patient complications have been reported as a result of this event.

• Brand Name: HEARTWARE VENTRICULAR ASSIST SYSTEM - PUMP
• Type of Device: VENTRICULAR (ASSISST) BYPASS
• Manufacturer (Section D): HEARTWARE, INC.; 14400 nw 60th ave; miami lakes FL 33014
• Manufacturer (Section G): HEARTWARE, INC.; 14400 nw 60th ave; miami lakes FL 33014
• Manufacturer Contact: paula bixby ; 8200 coral sea st ne; mounds view, MN 55112 ; 7635055378
• MDR Report Key: 14940693
• MDR Text Key: 295404184
• Report Number: 3007042319-2022-06404
• Device Sequence Number: 1
• Product Code: DSQ
• Combination Product (y/n): N
• Reporter Country Code: KS
• PMA/PMN Number: P100047
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Study,Health Professional
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 07/06/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/06/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Lay User/Patient
• Device Expiration Date: 03/31/2019
• Device Model Number: 1104
• Device Catalogue Number: 1104
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 11/29/2020
• Date Device Manufactured: 03/31/2017
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention; Hospitalization